Quick Hit: What Was that about us Burdening the Health Care System?

Apparently the researchers didn’t see it coming — but it turns out thin non-smokers are the most expensive to treat in the long run (vs. fatties and smokers) because, duh, they live longer. The difference over a lifetime is tens of thousands of dollars per person. Smokers have the most lung cancer (NO!), fatties have the most diabetes (NO!), and the skinnies have the most strokes (Oh, reeeealllly?).

I can see it now: NORMAL WEIGHT NON-SMOKERS COSTING THE HEALTHCARE INDUSTRY BILLIONS BY LIVING LONGER AND HAVING MORE STROKES!

Actual quote from the article:

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

People who live longer cost the health care system more? YA THINK?

Of course, in keeping with what we write about all the time here, I am awfully curious about how the researchers defined “obese.” As far as I know, only extremely fat people and underweight people have been shown to have a risk worth mentioning of earlier than average death, while garden variety “obese” folks aren’t much worse off than the “normal” ones and, of course, “overweight” is the best BMI category to be in, longevity-wise. So the fact that this article — if not the study itself — takes it as read that obesity = early death is… curious.

Still, it’ll be nice to have this link the next HUNDRED THOUSAND TIMES someone bitches about how much fatties are costing the health care system. I mean, I’ve always said that regardless of health care costs, if you really think you’re gonna outlive me by that much, don’t you feel guilty about all the fucking social security you’re going to suck? There’s a CRISIS, people! But this is the icing on the cake.

On the other hand, my latest response to those people has been that I don’t even want to engage the question of who’s costing the health care system “too much,” because I believe in universal health care; I believe that every human being should have the right to whatever medical care he or she needs, for whatever reason; and I believe discussions of who deserves adequate health care and who doesn’t are prima facie fucking repugnant. There’s that, too.

Post navigation

118 thoughts on “Quick Hit: What Was that about us Burdening the Health Care System?”

I don’t even want to engage the question of who’s costing the health care system “too much,” because I believe in universal health care;

I love my universal health care. But under universal health care, the idea of: “Those smokers and drinkers and fatties and people who dont’ wear their seatbelts are costing ME MONEY!” comes up even more than it does under private health care. (For some reason we’re not hearing it yet for fat that much in Canada, it’s still mostly directed at smokers. But I’m sure it’s coming, just look at England). I mean, I strongly believe in this: “I believe that every human being should have the right to whatever medical care he or she needs, for whatever reason” too, but a lot of people, well, don’t.

I never heard that much when I lived in Canada, but yeah, people do get nasty about smokers. Oddly enough, you rarely heard bitching about people who suffer catastrophic injuries doing extreme sports, or people who end up with myriad health problems from, say, serving in the military. Women who birth to preemies also get a total free ride! Heck, people sympathize, even, although we all know how risky giving birth can be.
:roll:

I hear you, Becky. But here’s the thing: I would much rather hear that bullshit while enjoying my tax-funded health insurance than hear it while I don’t have any health insurance at all because the cost is prohibitive. I don’t really see much of a difference in how much I heard people howling about various people “burdening the health care system” when I lived in Canada and how much I hear people howling about it here. Only real difference is, in Canada, I could go to the doctor when I needed to without wondering how I’d pay for it.

This type of whining is also very common in Finland, where health care is paid from tax money mostly. Someone once wrote that Americans pay for their own diseases and don’t have a system like ours, so there’s no real burden issue. Ehh.

Becky, great point. In private health care, if you feel like your being discriminated against because of your weight you at least have the *option* to drop that plan, or shop around (your actual ability to do this may vary). However, the government plan would put you in the hands of whatever lobbyists are lining the pockets of the regulators or legislators involved in determining the standards of care.

Do you *really* want your fate, as a fat person, to be in the hands of big pharma and the weight-loss industry, not to mention politicians who haven’t ever read an actual medical study in their entire lives, and just listen to lobbyists from ‘concerned groups’ all day, getting their facts from that questionable source?

That’s not to say that fat people aren’t discriminated against in the private system. But why take away your choices? Why deliver yourself and your body into the hands of the oft-moralizing body politic? Why divorce yourself from the ability to vote with your dollars, or your feet?

I’m very, very uneasy about having ‘the State’ be the ultimate arbiter of whether I, or my children, get care. We see how the NIH is fucking up healthcare in the UK. Also, WIC standards were recently changed to focus much more on ‘calories’ in an attempt to ‘combat’ the ‘obesity epidemic.’ Their reason? Well, it’s a government program that you’re getting for *free*, so screw what you think is nutritious or not.

Likewise, when they start imposing regulations on health and behavior under universal healthcare, their reason will be: Well, it’s a government program. You’re getting it for *free,* so screw what you think is healthy or not. Big Pharma X wants obesity classified as a disease, so that it can sell its pills (and us legislators get the peace of mind knowing we’ve stopped the ‘epidemic.’). And when it doesn’t work, we’ll send your kids to weight-loss concentration camp, because their public education is *free*, so screw what you think is your child’s natural setpoint.

The consequences are chilling. And if you think that this next administration won’t cave to those kinds of regulations, remember: bureaucracy is notoriously hard to “deregulate” once regulatory agencies have been put in place. And we’re always just one administration away from getting ignorant, paranoid bigots into office who will use the agencies created by their predecessors to gain popular support by scapegoating fat people, smokers, old people, poor peoples, ad nauseam.

Oh, hey, don’t try to enlist me on your side on your fight against universal health care. I said I support it, just that it doesn’t get rid of the problem of whiny assholes.

if you feel like your being discriminated against because of your weight you at least have the *option* to drop that plan, or shop around

If you have a BMI >30, or any kind of preexisting condition? Good luck finding even one plan that will take you, never mind a whole array of options.

Do you *really* want your fate, as a fat person, to be in the hands of big pharma and the weight-loss industry,

From what I’ve heard about the HMO system, it already is. Sure, you theoretically have the option of bypassing HMOs and insurance and paying all your health care costs out of pocket, but for 90% of the population that is such an unrealistic option as to not really count as an option at all.

I’m very, very uneasy about having ‘the State’ be the ultimate arbiter of whether I, or my children, get care.

The whole point of universal health care is that everybody gets care.

Likewise, when they start imposing regulations on health and behavior under universal healthcare, their reason will be:

Can you give some examples of that happening in actual countries with universal care?

In private health care, if you feel like your being discriminated against because of your weight you at least have the *option* to drop that plan, or shop around (your actual ability to do this may vary).

In my opinion, this is exactly why there is a need for universal health care: because your ability to find a new plan may vary to the point of nonexistance. Health insurance is expensive, especially if you are buying it without the benefit of a group plan through an employer. So assuming that you have a job that actually provides insurance (and that’s a big assumption to make since obviously there are a great many people who for whatever reason don’t work or have jobs that do not provide health insurance), the idea of buying a new plan on your own because your current one serves you poorly, is just not realisitic for many (if not most) people, especially those people who need it the most.

The current system leaves people at the mercy of a company who profits from insuring you, and then denying to pay for your care. Those with pre-exisiting conditions aren’t often denied coverage right from the start, and are either forced to go without healthcare or go into an unworkable amount of debt to stay alive. Other individuals are penalized for whatever perceived health risk factors they show, such as smoking and obesity, and they have to pay more for coverage, and again, if they can’t afford it…they are left out in the cold. The idea that universal health care is going to produce a controlled health care system were arbitrary decisions are made about who is eligible and what constitutes a disease is unfounded because it already exists, only instead of the government controlling it, corporations do.

While no system, private or public, is perfect, I’m sure no one would disagree with the idea that the current system needs improvement and that we need a health care system that covers all people. It is going to be work to set something like that up, that’s for sure, but it would be worth it in the end.

Do you *really* want your fate, as a fat person, to be in the hands of big pharma and the weight-loss industry, not to mention politicians who haven’t ever read an actual medical study in their entire lives, and just listen to lobbyists from ‘concerned groups’ all day, getting their facts from that questionable source?

This is not my experience of Universal Health Care at all, and I lived in Canada for 35 years. Health care is seen as a right – it’s damned hard to take it away from anyone, despite the bitching. Here in the U.S., I am fortunate enough to have employer-based health insurance, but I still have bureaucrats telling me what tests and medications I can have. Without the job, I would be completely unable to get health insurance.

Oh dude, important point: I just reread the article, and they were working off a model. Which means that the shorter lifespan for the “obese” was built in.

BWAHAHAHA! Also, what assholes. But hee.

Another note on Universal Health Care – speaking from the Canadian perspective : a politician who messed with the system and moved to deny care would be handed his or her ass. Politicians are a lot more accountable than Big Pharma or whatever nebulous monster controls the U.S. health care system. I’ve lived here for 7 years without figuring out who the hell is in charge.

I also never claimed that the system we have now is perfect. There are a lot of uninsured, and costs are prohibitive to many. I just think that universal health care has a lot of potential dangers that, say, giving people tax credits to pay for health care, or cutting their taxes period so they can keep even more of their own money (like, for instance, by the amount they’d have to raise taxes in order to enact a universal healthcare system), so that we have a choice between providers instead of some catch-all committee system run by the government.

And yes, private insurers are businesses. Which means that, if they’re truly *private,* they have to listen to their customers. The stats are 65% overweight and obese in this country. If one insurer discriminates against someone because he/she is fat, then another insurer will see easy money and offer a plan that isn’t discriminatory, hence drawing those alienated customers.

Sorry, the big paragraph was a bit f-ed up. I meant: “I just think that universal health care has a lot of potential dangers that, say, giving people tax credits to pay for health care, or cutting their taxes period so they can keep even more of their own money (like, for instance, by the amount they’d have to raise taxes in order to enact a universal healthcare system) doesn’t have, since we have a choice…”

These models of what healthcare costs are about are also NOT taking into account the fact that the skinny non smoker is more likely to have all their wellness visits- since they won’t be harrassed about weight or smoking concerns.

I am a reader over at First Do No Harm- a website about fat prejudice and health care. Lots of the horror stories have to do with the fact that bigger than life folks would rather stick forks in their eyes than go see a doctor. Care is not routinely sought- so costs could be significantly lower because of this— or higher due to situations escalating until hospital level care is required (the most costly care). This dichotomy makes it hard to really get an idea as to “costs.”

Which means that, if they’re truly *private,* they have to listen to their customers.

And the government has to listen to voters. Which the Canadian government does, at least when it comes to health care. If your government is not listening to voters, your problems go far beyond health care.

If one insurer discriminates against someone because he/she is fat, then another insurer will see easy money and offer a plan that isn’t discriminatory, hence drawing those alienated customers.

Not if they think those overweight and obese customers are going to cost them money in the long run because of the greater health risks associated with overweight and obesity. That’s the advantage of universal health care – they have to cover everyone, even people who are very expensive to cover. (That, and the fact that everyone can afford it).

By “demonstrably untrue,” do you mean that because there exists a universal healthcare plan out there right now that doesn’t actively discriminate against fat people, smokers, etc, that means all universal systems will not do so? I never said there can’t exist a healthcare plan that doesn’t discriminate, I said that we’re only one administration away from one that is made to be discriminatory.

As for having the choice between plans in the current system, that’s also not untrue. I didn’t say everyone had healthcare, or that everyone could afford to change plans based on various reasons (job, income, etc). In fact, I think I mentioned that, as we stand, the choices aren’t always there, but in theory you do have a choice between competing plans.

And I know what vitriol means.

I haven’t read either of the universal health care plans, because I’m not talking about specific plans of the moment, rather the dangers of getting a universal system in place when there so much misunderstanding of health and actual science by government officials.

I also never mentioned that big Pharma, etc weren’t involved with private health insurers. Like I said, what we have now isn’t perfect, but at least we still have choices. Perhaps better choices for more people can come out of initiatives that put the money we earn back in our hands, rather than giving it to the government to decide how best to spend it.

fillyjonk said: “Oh dude, important point: I just reread the article, and they were working off a model. Which means that the shorter lifespan for the “obese” was built in.”

Which also means that if we want to use the study to convince anyone that being fat isn’t more expensive, we first have to agree with the premise that being fat kills you sooner. So I’m not sure this study is really a win.

(P.S. that means being able to listen to polite, supported disagreement without calling it “vitriol.” Also off the table are “abuse” and “vituperation.”)

I find it difficult to give credence to your worries about how potential universal health care plans will be discriminatory, when you’re not actually aware of the ones that are on the table. I’m sure you can come up with a universal health care plan that discriminates against fat people, though I’m not convinced it would discriminate more than the current plan, which simply refuses them coverage. But why not actually look at the plans that are being proposed?

I can only speak for myself, but I’m definitely not trying to make you (BigLiberty) or anyone else feel attacked, but I did want to just pipe up about something I feel pretty passionately about.

I agree with the idea of tax credits for health care, but I think at the end of the day a system that provides coverage for all people would work better. While it is great to pay less taxes, I would be willing to pay more if I knew it meant that it would create a better life for me and everyone else. Too many people end up bankrupted by devasting illness or injuries, and they in a way are the lucky ones because at least they had the oppertunity to live and recover; so many die needlessly because they can’t afford preventative care to spot things early or because, once an illness rears it’s ugly head, they can’t afford the treatment.

I understand your fears, I certainly don’t want a system where the government gets to decide what and who they will treat; that’s just a bad replacement of what we have now. In my opinion what we need is a new model where people are treated, regardless of the why’s and wherefor’s of their illness or injury.

Yes Becky, the government does have to listen to voters. Thank goodness for that! But once a bureaucracy is in place, there are created regulatory bodies that aren’t, in fact, answerable to the voters under the current US system. And it’s been shown by history that once bureaucracy and its requisite regulatory bodies have been established, they usually grow rather than shrink, and are rarely abolished. Which means that if this system doesn’t work, it’s unlikely voting someone in who isn’t in favor of the system is going to abolish it; he/she will likely just cut its budget, or try to make *new* oversight bodies to regulate it the way he/she wants, etc. And the next administration could very well put it back to where it was, with the addition of however the previous administration grew it, that is.

Also, to answer your other point, Becky, the companies have no reason to believe that certain groups cost more money unless there’s evidence to support their claim. When things start getting launched into the public sphere, however, it’s not just about cost anymore. It’s about morality. If popular opinion is that fat people are child abusers if they have fat children, smelly, and icky, regardless of the facts, what kind of politician are they going to vote in, what kind of legislators are they going to vote for?

I really don’t want the fattists deciding whether or not I should get healthcare. Is the private system perfect? No. But it’s *just* based on money, while a public system is based on money, morals, and populism (by its very nature. Whether its end product is discriminatory is, like I said above, variable).

I really don’t want the fattists deciding whether or not I should get healthcare. Is the private system perfect? No. But it’s *just* based on money

But it’s really not. When I tried to get private coverage I was turned down by two insurance companies, and finally sent information on a pool for “uninsurable” people where the premiums were like $400 a month. (Okay, that’s “just based on money,” but it’s also based on whether I want to have health insurance or groceries.) Can a system where people can be completely shut out for being fat really be preferable? It’s not as though we’re safe from being denied care or surgery under this system either.

“And the government has to listen to voters. Which the Canadian government does, at least when it comes to health care. If your government is not listening to voters, your problems go far beyond health care.” (Becky)

BINGO.

And Doodlespook – indeed, the stockholders pull the strings to some extent, but if the price of stock dwindles because people are choosing not to purchase insurance with X company due to lack of care/discrimination/etc, these stockholders will sell and jump ship for the next lucrative company. And around it would go. Theoretically, it’s about corporate- (in this case Insurance companies)- accountability. Which is a stretch, i know.

fillyjonk, the ‘vitriol’ comment was because of Becky’s assumption I was trying to enlist her. I apologize, Becky, because I think your intentions were good and perhaps I read it a bit more ‘attack-y’ than it was. I also apologize to others if they thought I was implying I was being attacked by every single commentator who was discussing my original comment. It was quite civil.

Also, fillyjonk, I disagree with a universal health care system in principle, and also practically since, like I mentioned above, having the system in place can lead to future abuse by not-so-nondiscriminatory administrations. Once something is in place, it can be expanded and redefined.

I’m, of course, assuming that a universal healthcare system is defined by being a government plan that services all, without integration of any private organizations, and which doesn’t allow you to choose between *competing* plans (rather chooses for you), is entirely tax-payer funded with the exception of copays. I’ll take a look at those plans, but tax credits and so forth aren’t, in my definition, part of a universal health care plan. In other words, just because a politician may say something is universal healthcare (like Massachusetts claims its mandatory system is universal healthcare, for instance), doesn’t make it what I understand to be the standard definition of universal healthcare, to which I’m opposed for reasons stated above.

I’m, of course, assuming that a universal healthcare system is defined by being a government plan that services all, without integration of any private organizations, and which doesn’t allow you to choose between *competing* plans (rather chooses for you), is entirely tax-payer funded with the exception of copays

Okay, that’s purely theoretical at this point (for the U.S.), so as long as you’re acknowledging that it’s a hypothetical discussion, carry on. I do recommend reading the Clinton and Obama plans, though, because they don’t fit your criteria, and they’re the ones that are realistic. (Insofar as they’re realistic; I think it’s naive to imagine that either one will be enacted as-is.)

I think most people here are using “universal health care” to mean “health care where insurance companies are forced to cover everyone, instead of cherry-picking the people that they think will cost them less.”

I disagree with a universal health care system in principle, and also practically since, like I mentioned above, having the system in place can lead to future abuse by not-so-nondiscriminatory administrations. Once something is in place, it can be expanded and redefined.

All I can tell you is that I have intimate experience of the U.S. and Canadian health care systems, and the Canadian is a million times better. I suppose the U.S. system is better if you happen to be a very rich person, but alas, I’ve never been very rich.

I think most people here are using “universal health care” to mean “health care where insurance companies are forced to cover everyone, instead of cherry-picking the people that they think will cost them less.”

Hmm, maybe the Americans. Personally, I was referring to a system where everyone pays in through taxes, and everyone is free to use it – isn’t that the standard definition? I actually agree with BL that just because Clinton and Obama call their plans universal health care doesn’t mean they actually are – from what I read, they’re not really, although they’re certainly a step up from the current system.

BL, my comment about you enlisting me was probably unecessarily confrontational and I apologise. I’m just passionate about the issue and didn’t want people to get the idea from reading your comment that I oppose universal health care when it’s very much the opposite. It was an interesting discussion for sure =)

BigLiberty, i think your fears are well-founded, given the track record of lies, obfuscations, and general disingenuous dealings of the current administration. Universal Healthcare would be a welcomed change, however, as Fillyjonk states, and i second, neither Clinton nor Obama’s plan will ever be applied in it’s theorized form.

Insurance companies will not be on the losing team if universal healthcare gets applied. Big Government won’t allow that to happen, for who then would finance their campaigns? And Big Pharma won’t lose financially in this process either, because who then would fund the FDA?

Thanks for the responses to my comment, everybody. Becky, no harm done, I was too defensive. Very interesting discussion, I’ve learned a lot about, at the very least, the differing perceptions between what it means to have universal health care. I have to get back to work (which means waiting for a lot of boring programs to compile, lol), but thanks to everyone again.

All I can tell you is that I have intimate experience of the U.S. and Canadian health care systems, and the Canadian is a million times better. I suppose the U.S. system is better if you happen to be a very rich person, but alas, I’ve never been very rich.

Ditto.

And it’s a good point that the “universal” health care proposals on the table are not, in fact, like the Canadian system. But what we have now sucks so fucking much, I’ll take any step in the right direction.

I’m with Fillyjonk and the others who note that this study’s not a win, as it again allows for the argument that, “Yeah, thin people cost the system more, but only because the fatties DIE earlier.”

The AP report never mentions where the “Fat people die early” stat comes from, or that it’s based on a model. Nor does the article at all reference the study that suggested that fatness actually protected against disease.

So no, I’d say it’s definitely not a win at all, and it’s the kind of article I’d consider problematic even if it *seems* to be on our side.

I believe that every human being should have the right to whatever medical care he or she needs, for whatever reason; and I believe discussions of who deserves adequate health care and who doesn’t are prima facie fucking repugnant. There’s that, too.

I totally agree with your second statement, the idea of “deserving” to be treated for an illness is just gross.

But I can’t really get on board with the idea of health care as a right. And I know this is an INCREDIBLY unpopular stance to take, and I don’t really expect anyone to agree with me.

Saying that health care is a right, is essentially taking away the rights of doctors. This is essentially saying that everyone on earth has the right to demand time and effort from people who spent years and gobs of money to become highly trained professionals. This would mean that training to be a doctor turns you into a public servant, even though the public did not pay for your training.

I know that no one is really proposing not paying doctors anymore. But essentially Universal Healthcare means that instead of our insurance company paying the doctors the government would. (And we all know how well the government pays.)

I just think it is important to note that removing financial incentives for people to become doctors or nurses or other healthcare professionals is not without consequences. This means that people will now go to school for many years, work their butts off, to become doctors so that the government can tell them who to treat and for how much.

Eventually fewer people will chose to become doctors, and then we will have fewer people whose time and skills we all have a “right” to. So who gets treated then? I imagine it is the people with private health insurance and private doctors. Which puts us back in the same situation where only the wealthy have adequate health care.

I’m just saying, healthcare is not like water, or air, it’s not even like shelter which you can build yourself or food you can grow yourself. Unless you yourself are a doctor,
HealthCare is an individual taking time and expertise from another individual, and I just have a hard time seeing how that is a right. Even if it means the difference between life and death, I do not think I have the right to someone else’s skills.

The article I read about this study stated that the “normal” group was said to live to 84 while the overweight group was averaged at 80 years. So, they decided that weight takes 4 years off of your life, I guess. Smokers lost more years, of course.

I wasn’t clear if this was a model or actual numbers on average from a group they studied. Naturally, the article I read didn’t bother to mention any of the important details about how the study functioned. They hardly ever do.

You know, “a study shows. . . ” and then the big idea and if you are lucky at the bottom we find it was a study of 100 people in Finland for one year, and you go, “okay, but that doesn’t seem like a good study to base such pronouncements on in such a definite tone”. Most people never get that far though and so the news becomes the headline. Sigh.

Y’know, I’m as critical of my NHS med care as the next person, especially having a crappy doctor and all, but seriously it’s not anywhere near as problematic as all the hype. You think the House of Lords would let a bollocks proposal about denying healthcare go through?

Besides, universal healthcare has just so many benefits that it is worth the odd bit of looney “science” from the government. Especially considering that every time one of the politicians proposed something crazy, all his opponents from Lib Dem, Labour, Tory, Green, UKIP, Monster Raving Looney Party and the lot hound the poor bugger out of naked opportunity.

IIRC there are in fact fewer doctors per capita in Canada than in the U.S., but I don’t know anything about the reasoning for that. And if it’s because the people who want to help the public become doctors and the people who want to make lots of money do something else… I’m not too upset about that.

Certainly people do go to school for a zillion years in order to make no money, or we wouldn’t have professors. As long as the schooling is subsidized, I doubt you’re going to completely lose the doctoring population if the compensation is less outrageous.

Sniper Said:
“Of course, the whole mindset behind this study is screwed up. Are we seriously going to judge human beings by how much they cost the system? Apparently, yes.”

Yeah, in the version of the article I read, an anti-obesity person was saying, well, okay, IF the study is true, it doesn’t matter because obesity is still evil and must be stopped. But the person also implied that they have been arguing the obesity raises our health care cost for awhile and still believe it. We all know the trolls come here and say, drop the donuts because you are costing us money in our healthcare system. We DO have people who think it is a serious argument to judge people by how much they cost us. Sigh again.

Honestly, I’m not worried about doctors salaries. They have to be kept fairly high to keep people interested in all the years of training it takes. I would think you would probably see more PAs and nurse practitioners doing basic clinical stuff in universal health care which would probably balance out demands on general practitioner’s time.

And people have to get a degree (4-5 years in Uni) and continue to take classes throughout their career in order to get paid terrible money to teach and I don’t think the solution to that is to create a system where a % of families will never be able to send their children to school, so I don’t see healthcare as any different.

And if it’s because the people who want to help the public become doctors and the people who want to make lots of money do something else… I’m not too upset about that.

Doctors still make a sweet living in Canada – it’s an excellent ,high-paying, well-respected job. Doctors live in fancy houses and drive nice cars in Canada, although I’ve never heard of a zillionaire plastic surgeon in Canada. They may exist, I’ve just never heard of them. Also, thanks to low tuition and generous support, doctors and lawyers (and architects, and teachers) don’t start their professional lives with crushing debt. Weird lawsuits are also not so much of an issue.

Shinobi, I’m thinking about your point, and I’m thinking – a lot of people work for the government. Teachers are a big one. Police officers, fire fighters. Sanitation engineers. The military! Do you also find it problematic to say we have a right to an education, to security, to clean water and a sanitary living space? That’s the idea behind a social contract, isn’t it? You pay taxes and obey certain rules, and in exchange you get certain things. Of course it would be wrong to forcibly compel people to work for the government. But if you don’t want to work in the public education sector, you don’t choose to be a teacher. And in Canada, if you don’t want to work in the public health sector, you don’t choose to be a doctor. (Or you choose to be a doctor in a discipline that’s not covered under the public sector, like plastic surgery). What I’m getting at here, not very clearly is – under a public health system nobody is forced to treat patients against their will. They’re choosing to treat patients. The only difference is that their paychecks are coming from the government rather than an insurance company or directly from the pocket of the patient.

I’m not sure I wouldn’t rather have a doctor who became a doctor to help people, rather than to make gobs of money.

But it’s not that simple, fj. I’m in healthcare communications — specifically oncology. I think every couple of weeks about how I should, really, have become an oncologist, and how great that would be. But I don’t consider it for long, because 2 years getting my prereqs, 4 going to medical school, 3 doing an internship and a residency, plus maybe a year of whatever extra specialization after that, figuring in tuition, cost of living AND (since I’d be a midlife career changer) forgoing that many years’ worth of the adequate income I currently make … to do this would cost literally hundreds and hundreds of thousands of dollars. And it’d really be 24/7 — I wouldn’t have anything else in my life to speak of for all those years. So, help people? GOD YES. But money counts too. Because the cost in money and life energy of becoming a doctor, even starting out young so you can drop out most of the foregone-income factor, it’s just incredible.

Sorry, slightly tangential rant there. Point is, yeah, healthcare providers are important to take into account and shouldn’t just be considered a rapacious overpaid money sink.

But if you’re still making the money only without the debt, where’s the trouble? I don’t see anyone saying that doctors in Canada are paid as poorly as, say, people who only spend four years in undergrad, six years getting a master’s and Ph.D., and two years of postdoc in order to teach.

Point is, yeah, healthcare providers are important to take into account and shouldn’t just be considered a rapacious overpaid money sink.

And yet… I can’t help but wonder how much my doctor charges for spending 10 minutes with me, handing me some samples, and charging out the door to her other patients before I can ask a question. I realize there’s overhead, I realize there are other costs, but I sitll think the sheer amount of money spent on health care (and health care denial) is insane.

Even if it means the difference between life and death, I do not think I have the right to someone else’s skills

So you never use the time of anyone you don’t pay directly? You don’t use the US postal service, Army Corp of Engineers, FTA, the military, lawyers, judges, police, sheriffs, life guards, the fire department, etc. etc, etc? I think that’s a nonsensical stance. There are lots of interesting reasons for rejecting vaccination, for example, but I’ve never heard of anyone saying no because they didn’t want to abuse the time and expertise of CDC workers who developed the vaccine.

Routine 10 minute appt = not that much $. The nominal cost is all artificially inflated because of the retardo employer-based private insurance system we have now, which I do NOT support — the doc doesn’t actually make what it says on the piece of paper you get.

If training suddenly became free, maybe it’d be different, but one, how do you grandfather in all the 40-year-old specialists who’ve already coughed up a quarter million or half million in training and sunk costs? Two, I know what you’re saying about how there’s a high effort-to-income ratio in academia as well, the humanities anyway, but I think there’s a fundamental difference between an English professor and a liver surgeon or a gastrointestinal cancers specialist. I used to be in English myself, I love and believe in literature as a discipline, but it’s not equivalent as far as value added to society or to individuals. I’m probably not being very clear.

All I know is, we need something better, whether it’s universal or serious regulations to our single-payer system. It is wrong that perfectly healthy fat people are denied medical coverage simply because they’re fat and have a family history of heart disease, diabetes, inc. Just because your grandparents or uncle has it doesn’t mean you will. The same can also be said for thin people with bad family histories.

Of course, we could just drop 50 lbs and get insurance, but what happens if we do and lo and behold we start getting conditions due to the weight loss? Wouldn’t that be more of a drain on the system than a 300 lb person who does not have serious medical problems? Or, we lose weight but are still considered obese and uninsurable?

Like we say to the fattists, stop looking at size and BMI to determine health. The medical industry needs to do the same thing.

You know, France has a better healthcare system than the UK or Canada, better care than the US in a lot of ways. I wish more of our policy wonks would look there. The NHS is great for things like emergency care in case of an accident, but you don’t ever want to have to get cancer treated in the UK. (Not that you want it anywhere, but you know what I mean.)

I worry that we’ll end up with some of the kinds of extreme rationing seen in the UK and I do also worry a little, like the poster upthread, that any universal system we install in the current climate will put toxic mandates in place around obesity and overweight. But let me be clear, I’m not advocating for the current system as any kind of solution. It freaking sucks and I hate it. It’s just not like there aren’t going to be difficult tradeoffs and a new set of overhead costs in any fix I can imagine us making.

I’d like a system where we don’t complain about helping out sick people. This whole topic gets me all angered up. My partner’s mother had breast cancer and was self-employed. She was unable to get insurance (after a divorce) and spent the last few years of her life scrambling to cover medical bills (which, obviously, she couldn’t). Do we really want to talk about a basic human right like health as being too expensive?

Out of curiosity, Lisa, how are you tallying up the monetary value of contributions to society?

You know, I never hear anybody complaining about their car insurance premiums being used to help all those OTHER drivers. Technically I guess I should be upset that bad drivers are allowed to have the same insurance as me, but I don’t think of car insurance that way; I think of car insurance as “I’m paying this now, so that when something happens I am not up shit creek.” (Even though theoretically the other person’s insurance would pay, not even mine! But the last time someone smashified my car it was a hit and run, so I depended on my insurance co. even though it wasn’t my fault.)

An interesting “side-effect” of my experience with Canadian vs US health care is that in Canada, some of the impetus of health care is put back on the patient. What I mean by that is, because doctors are quite busy (fewer per capita), they expect you to be very specific with your symptoms and appreciate it if you have done some research about what might be the issue. In the States, if you’re lucky enough to have health care, you can walk in with a cough and expect an antibiotic, no thought given whatsoever by the patient other than, “I feel icky.” That, of course, is in my limited experience (I’m 33 and getting my very first long-term prescription drug today – lucky me!).

I would also like to know what factors in the study caused the “obese death rate” to be lower – what fatal diseases did they attribute to obesity? It’s an interesting model though, and I’d like to see what would happen if they applied it to real people in a further study.

Is there widespread concern that physicians, and apparently only physicians among health care workers, are going to suffer an immediate and dramatic decline into poverty should some form of universal healthcare be instituted?

Could we perhaps spare some concern for the vastly overworked, underpaid, often uninsured millions of nurses aides, orderlies, cafeteria workers, nurses, physical therapists, and others who are already getting a crappy deal in a system that, just like corporate america, provides a lavish income to a few while providing little to the majority? The people who actually turn your body in the hospital bed so that you don’t get bedsores are the people most likely to get workplace injuries, and are the least likely to have medical coverage themselves.

FJ: As a property-casualty insurance agent, every day I hear someone complain about their car insurance premiums for just that reason. :) Usually about how all the uninsured drivers are causing accidents and making insurance rates go up, and then of course how it’s the fault of illegal immigrants (rolleyes). But that’s an entirely different discussion.

I know it was clarified above, but it merits repeating: health care is not the same thing as health coverage. However, my friend said it much better in his eloquent rant here. He writes:

Health care means people get treatment when there is something wrong with them. Health coverage means people get insurance, which does not guarantee treatment

. I think it is important to repeat that distinction, because many people are confused about it.

Although I work for an insurance company, I do not support subsidizing insurance carriers to expand the coverage they provide. In a true universal health care environment, health insurance is not required.

Actually Kaethe, i’m mostly concerned about the quantity of pysicians, nurses, nurses aids, orderlies, cafeteria works, nurses, physical therapists and others that will go into the health care industry after the government is in charge of paying them. Wages in that industry will be increasing, espeically with the boomer generation getting older. There is already some concern about not having enough health care workers. If the government doesn’t pay them enough then we will need to be even MORE concerned about it.

A short supply of health care workers will mean that people cannot be treated for their illnesses not because they can’t afford it but because there is no room and no one to take care of them.

Hopefully any government plan that is put in place which now seems inevitable, will plan for this. My confidence is not high.

Usually about how all the uninsured drivers are causing accidents and making insurance rates go up, and then of course how it’s the fault of illegal immigrants (rolleyes)

Actually, now that you put it that way, I guess I have heard that argument. Just not from anyone I want to listen to. :)

And the health care vs. health coverage point is a great one. The Democratic candidates in the US are supporting universal coverage. The pitfall with the distinction, though, is that some opponents claim that we already have universal care in the States; you CAN get health care if you need it, you just have to be willing to go into debt. In a system like the one we have right now, costs for the uninsured are so exorbitant that technically-universal health care isn’t enough. But I agree with your last point, for sure.

If universal health care turns doctors into public servants, what does the idea of universal education make teachers?
If we want teachers to have respect we need to privatize education? Oh wait that is already happening, we are headed backwards, eventually we will be serfs again.

Not to mention what is wrong with serving the public? Helping people is the reason most doctors get into health care int he first place.

For what it’s worth, I don’t think a Canadian-style system would work in the U.S. simply because of this country’s culture. Keep in mind that this is just my take as someone who has been perpetually bemused and baffled since I moved here, but it seems like in the U.S. it’s understood that corporations have a “right” to make as much money as possible, but that individuals have the “responsibility” to take care of themselves, no matter how difficult that is. To many, many people I’ve met here it seems far more reasonable for a cancer patient to have to divorce and declare bankruptcy than it is to have the government regulate business.

Shinobi42, wages are only increasing for the most highly paid health care workers. Everyone else has seen declining wages and benefits for years. Sure, there’s concern about not having enough workers. But not enough concern to offer them a living wage, or enough hours per week to get insurance.

What reason do you have for supposing that the government would treat health care workers worse than private for-profit companies do?

We do *not* have universal care. Non-emergency treatment is denied to millions of Americans. Preventive care is denied to millions. Drug treatment is denied to millions. Mental health treatment is denied to millions. Prenatal care is denied to millions. Long-term care is denied to millions. Dental care, and hearing tests and eye tests are denied to millions. Oddly, your life-saving treatment is considered a bad risk by lenders, so you cannot get treatment if you do not have coverage or cash up front.

I totally agree with you, just to be perfectly clear, but I hear the argument a lot from people who really don’t understand that “you could buy it if you had infinite money” is not the same as “you have access to it.”

And yes, private insurers are businesses. Which means that, if they’re truly *private,* they have to listen to their customers.

They get to cherry pick their customers in the first place. You don’t just get to “decide” to be their customer by showing up with the money for premiums, like you do if you’re walking into a shoe store. They don’t WANT most of us for customers; they RESENT the fact that there are laws involving employees being eligible for group coverage in the first place and would love to get those laws struck down so they could prune out those of us whose ONLY option for health care AT ALL is having a job that covers it. (Like FJ says, if you have a BMI 30+ and/or any kind of preexisting condition, forget about shopping around for a private policy. Even if I lost significant weight and got my BMI below 30, I’d still be out because I have a history of PCOS and psychiatric treatment.)

If they could legally choose to cover only young, thin, nonsmoking, teetotaling, celibate, athletic-but-unadventurous males (females have babies, very very expensive!), they’d be all over it in a second.

But here’s an interesting thought about “health care costs” for ya. In a for-profit system, there’s no way to make Big Pharma and Big Insurance equally happy; you need prescriptions to take pharmaceuticals, and prescriptions involve doctor visits (often accompanied by lab work), and doctor visits mean claims. So it makes you wonder why Big Insurance, instead of yowling about all the expensive fat people, isn’t calling instead for Big Pharma to cease all those “a little uncomfortable? ask your doctor about drug x” ads instead. That would save them a buttload more than screaming at us not to be fat at them.

Seriously, “The emergency room can’t legally turn you away” is not the same as adequate, affordable health care for all. It’s not in the same galaxy as that.

This one fucking kills me. I teach at a poor school (which is a discussion for another day) and many of my students’ parents work two or more low-paying jobs. Almost none have health insurance, which means they go to the emergency room or the free clinic and only when they absolutely have to. One of my students recently lost her baby sister. The mother’s first and only doctor’s visit was in the emergency room as the child was being delivered – with a cord around her neck.

I’m not saying this would absolutey not have happend if she’s had pre-natal care. I do wonder, though, just as I wonder about another students who died of a rare heart condition. She had felt terrible for months and months, but couldn’t see a specialist because she only worked 37 hours a week – not enough for health insurance. Yes, she had taken advantage of the free services available, but those doctors dismissed her symptoms as fatigue.

Well, there’s one way to make them equally happy: the insurance company runs the prescription drug benefit. They make money off of every prescription filled. Sure, there’s more doctor visits, but those blood tests are practically automated, and phlebotomy is cheap, considering.

OK, this reminds me of a study I read about in biking magazine….So anyway, it turns out that people who bike commute to work end up putting out more carbon emissions & greenhouse gasses than people who drive their cars to work …Why? Because even though they consume fewer resources and put out fewer carbon emissions per day they end up living longer. Ah, the irony of unintended consequences… ;-)

There are currently almost 47 million uninsured Americans. They are considered unprofitable to treat for illness by hospitals, doctors, pharmaceutical companies, etc.

The fundamental case for universal health care is that poor people have the right to be treated for illness, whatever their profitablity, and shouldn’t be left to die from treatable diseases because they couldn’t afford treatment. Do we want to be a society with any safety net at all or not? Especially since most of us are a pink slip away from joining the ranks of the uninsured.

I obviously come out on the side of universal insurance and I don’t really care if I end up paying more in taxes for it. It’s both in my own self-interest and in the interest of society to do so.

I agree with Kaethe (I mean your first comment above… though your comment about the orderlies and other caregivers is so true also) that there are many other things that we view as “rights” in this country that are provided by trained professionals whom we don’t pay directly, even though the professionals (teachers, engineers, public defenders) had to pay for their own education. In my case, city dwellers expect that the water that comes out of their tap will be clean and safe to drink, so the government pays the consulting firm I work for (and by extension me) to make that happen, and theoretically society benefits. I paid for my own education and nobody is doing business with me on a one-on-one basis to “buy” water treatment expertise, and that is OK because we consider clean water a “right” or at least a reasonable expectation in civilized society and I am paid sort of on that basis. (Personally I think health care should be the same.) On the salary front, although engineering is fairly lucrative and well-respected as a profession, civil/environmental engineers often do make less than other types of engineers, but this doesn’t seem to stop qualified folks from going into the field, probably because the pay and prestige are a “good enough” motivator for people who are otherwise interested in science, problem-solving, to some degree helping people, etc. IMO a profession doesn’t have to be the absolute highest paying to still draw qualified people. Anyway if, as some here have reported, doctors make a good living in Canada despite “contracting” with the government, I’m sure they would also do fine here if we had a similar system. Medicine is a challenging field that requires a special type of person to be successful at it, and I think that generally recognized fact would continue to be rewarded with prestige and decent pay.

On a similar topic to this post, did anyone hear the discussion on Diane Rehm this morning that someone else gave the heads-up about in comments to the previous post? I was out driving around and really wanted to call in, but my cell phone was dead. The author featured on the segment mentioned some numbers I think similar to those described in this article, and was talking about how it quickly became problematic to try and save costs in health care above all else, but that it was by no means clear in any case that the obese were costing society more in health care than other groups of people. Unfortunately the “dollars and cents” nature of the argument also meant he was getting into the realm of talking about how people cost society less if they die early. This both encompasses potentially bad assumptions about weight, and is sort of appalling from a human compassion standpoint as others in this thread have pointed out.

He was generally making a fairly unusual pure economic argument about obesity–the idea that sometimes people don’t eat right or exercise because they are making a conscious or unconscious choice to spend their time pursuing other goals at the expense of the “hard work” required to stay thin. I thought in some ways it was good that he was questioning the idea that a) everyone has the time and mental energy for endless exercise and dieting, and b) these things are always the best choices for an individual when you take their whole situation into account. The guest host from CNN was being IMO an asshat–you could tell he was just sneering at the idea that obesity may not be de facto the most expensive and debilitating thing that can happen to a person, and he kept bringing up tired crap about huge sodas in the vending machine at schools (not that you don’t have a point, but dude, we have all heard this every time we turn on the radio for the past 10 years), and once said something like “So I have a very low-calorie snack in front of me, should I feel guilty about eating it?” Huh? The segment is about your snack how? He wasn’t helping but the author was making at least a little sense. In this day and age, when I saw a bank commercial the other day sentimentalizing the idea that a middle-class dad was having to work a paper route to afford braces for his daughter (I’m sorry, this is not something we should be celebrating in the “greatest nation in the world”), the idea that people “don’t have time” to exercise or cook meals is becoming more and more a fact of life, and less easily dismissed as an “excuse.”

However, the same old assumptions were still there–that the author’s hypothetical workaholic “Uncle Albert” that he used as an example was fat solely because he didn’t constantly watch his diet and spend hours exercising like the author’s blue-collar father, who I’m sure was a perfect paragon of health in all his habits (he was thin, remember, so he must have been); and that obesity is a culprit both in causing every ailment under the sun, and in the “skyrocketing costs” associated with treating all those ailments.

The great positives were that he mentioned that the overweight category was actually lower-risk for mortality, which if people say it enough perhaps listeners will finally get it through their skulls; and he pointed out an interesting study that I had not heard about where overweight and obese people were asked what their increased chances were of getting various illnesses, and how many years earlier they thought they would die because of their weight. Apparently the subjects actually overestimated their risks due to their weight (and that’s without mentioning how the “actual” risks are probably exaggerated estimates anyway… what do you want to bet the researchers expected to find dumb fatties blithely unaware of their impending death or debilitating illnesses?).

Anyway, the discussion was interesting and sort of problematic at the same time, and I was wondering if anyone had been able to listen more closely than I did and whether any good FA points were made later in the segment.

I often lean toward more socialist public policies, but since I met my bf, I can at least somewhat understand the Libertarian arguments, such as Lisa’s. If we allow for competition among insurers, and we also instate a flat tax of, say, 10% for every single worker, then people would keep more of their money and purchase their own health insurance (ideally). I do agree that in such a system, there would be a company that would insure pretty much everyone, and costs would need to be kept somewhat reasonable in order for that company to survive.

I get that part. But the argument breaks down (in discussions with my bf) when I ask about healthcare for the poor. His solution is that when everything is privatized, individuals will contribute more of their money to programs to help those in need. I just don’t know if I believe that much in humanity.

His solution is that when everything is privatized, individuals will contribute more of their money to programs to help those in need. I just don’t know if I believe that much in humanity.

This is one of the reasons why I can not get on board with most libertarian arguements. The idea that businesses and individuals would help those in need if only they were allowed to exist in a no-to-very low tax, totally free-market economy, is the stuff of Ayn Rand novels; it just would not happen that way in real life.

Speaking from the Libertarian standpoint (which I am not, and am simply discussing points that come up when I have this discussion with the bf), the reason that there is not such a company now is because we don’t really have a free market system. We also have large insurance companies that are able to cut deals with health care providers, not leaving much negotiating space for other, smaller providers that might be interested in making money, too. In a system where there was pure competition, services would be provided by enterprising individuals and groups to meet demand. Meaning that there would be both insurers and doctors that would go into business to serve all segments of the population.

way up the thread (i think FJ said it?) someone mentioned that they weren’t able to get insurance for less than 400 bucks a month. This could be (probably is?) b/c the smaller insurance company is not able to make as many great deals with health care providers (so that insurance company has to pay much higher rates to the doctors, and thus the consumer pays higher rates to the insurance company).

His solution is that when everything is privatized, individuals will contribute more of their money to programs to help those in need. I just don’t know if I believe that much in humanity.

The alternative argument is that lower taxes means we’ll all be able to afford what we need. This argument is completely crazy if you know how much things cost.

Real life example: A school principal makes decent money – $70,000 a year. He’s in good health, as are his wife and daughters. They have good insurance. They conceive another baby, as planned, and all is going well until the baby is born three months early with absolutely no warning. This child is now nearly a yaer old and her medical bills are in the millions. Seriously. Millions.

How on earth is someone supposed to plan and save for this kind of thing? Hell, I was in a fender bender a few years ago. The uninsured driver skipped town. Thank goodness my insurance covered most of it, but the ambulance ride and the 20-minute hospital stay cost $15,000. It would take me years to pay that off, and that’s not even an extraordinary medical bill.

Kristin, in that case it was actually because it was a high-risk pool for “uninsurable” people. The size might figure in, but there’s also an assumption that they will have to pay out more, so premiums are much higher.

I would be uninsurable due to my psychiatric diagnosis, which is why I can’t afford to be without a full-time job.

I had been soured on the whole universal health care thing, mostly because of comments from those of my friends who have made an intentional choice not to pursue full-time employment. They are uninsured now and in favor of getting health coverage for free from the government. I have struggled to obtain and keep full-time employment in order to support myself financially and stay insured. I know that if I get caught between jobs for too long I will not be insurable (nor will I be able to pay rent) so I’ve made it a priority to keep my job.

When I read the comments you all have written, I definitely agree that everyone should have coverage. I know that not everyone can obtain full-time employment, and obviously not everyone with a part-time job or three is doing so deliberately as a lifestyle alternative to the ol’ 9-to-5.

Universal health care could be a solution to all kinds of problems. What if everyone who suffers from debilitating symptoms had access to the best diagnostic and treatment tools available? What if people could get real treatment for their psychiatric symptoms instead of just getting jailed for them? What if people could return to work and not be afraid of losing their disability benefits? I think universal health care could boost our economy, and boost our productivity, and help hundreds of thousands of people return to the workforce.

I think I mis-spoke up there when I said “I do believe…” ’cause I really do go back and forth. I guess if I accept the premise that in a true free market services arise to meet all demand, then it would follow that I would also believe that the “uninsurable” under the current system would be insured in the true free market.

Also, FJ, when I had to get individual insurance when I was between jobs, I only had to pay 110 bucks a month for a pretty good plan (it would have been 90 if I didn’t smoke). My point is, and extra 300 or so if you’re fat, but only 20 extra if you smoke? Give me a break.

Kristin, you may have a point when it comes to insurance for people with risk factors like obesity. But what about people with pre-existing conditions that are expensive to treat? It’s not profitable to insure those people, so nobody would do it under a free-market system.

The idea that businesses and individuals would help those in need if only they were allowed to exist in a no-to-very low tax, totally free-market economy, is the stuff of Ayn Rand novels

You give Ayn Rand too much credit. In Ayn Rand novels, the people who help the poor are the bad guys. The good guys let the poor starve and die, because that’s what they deserve for not pulling themselves up by their bootstraps and making some money.

His solution is that when everything is privatized, individuals will contribute more of their money to programs to help those in need. I just don’t know if I believe that much in humanity.

This has already been tackled, but… yeah. That’s a LOT of faith in humanity right there.

How on earth is someone supposed to plan and save for this kind of thing? Hell, I was in a fender bender a few years ago. The uninsured driver skipped town. Thank goodness my insurance covered most of it, but the ambulance ride and the 20-minute hospital stay cost $15,000. It would take me years to pay that off, and that’s not even an extraordinary medical bill.

Dude, no kidding. I cut my finger on a soup can a couple years ago, and it was almost $1,000 for stitches and a tetanus shot. And I’m still sitting here uninsured and praying my appendix doesn’t burst/I don’t get into a bad car accident/etc.

Seriously, “The emergency room can’t legally turn you away” is not the same as adequate, affordable health care for all. It’s not in the same galaxy as that.

Even more so given that it isn’t “free” care to the extent that yes, the hospital will bill you, and if they can’t collect, that cost gets passed on to everyone else.

And yes, private insurers are businesses. Which means that, if they’re truly *private,* they have to listen to their customers.

But they haven’t been. If they don’t want to take you on as a risk, they don’t, and you’re not their customer. It’s that simple, and there is no insurance company in the world that is going to want to serve only (what they consider) a high-risk pool.

I just want to mentioning something, because I see the UK and the NHS brought up a lot in argument about universal health care.

In the UK, it’s perfectly possible to buy private health insurance if you want it, or pay for private health care out of your own pocket. Doctors, even doctors working for the NHS, can have private practises and see patients privately. There are entire private hospitals (which often also perform contract work for the NHS). So while there is universal healthcare, free at the point of delivery for all, there’s also private healthcare for those who can afford it and want to spend the extra money on it.

I suspect that a lot of people in the US don’t know this, because it never seems to be mentioned.

I would be uninsurable due to my psychiatric diagnosis, which is why I can’t afford to be without a full-time job.

Which is just fucked up beyond measure, isn’t it? I mean, how many people simply cannot work full-time-with-bennies because of their psych illnesses? Even if you’re on meds that control the worst of your symptomatology, those can make you too drowsy even to drive a car, let alone sit up or stand up alert for 8 hours a day. And that’s just scratching the surface of potential issues there.

About 12 years ago, I worked as a collections agent for the credit card division of a national department store chain. (The most miserable, soul-sucking job ever.) Even now, I can still remember one family’s story.

After years of kidney disease and dialysis , their 10 year old son had received a kidney transplant. The extended illness + surgery maxed out their health insurance million-dollar lifetime payout. So they were paying over 1K per month out-of-pocket for the anti-rejection drugs he would need to take FOR THE REST OF HIS LIFE.

They had sold their home and moved to a rental property, they had depleted their savings, and the husband (a delivery driver for UPS or FedEx or some such), was about to cash in his 401K just so they could pay their bills current and keep their heads above water for another couple of months.

Yeah, somebody needs to tell this family how universal healthcare would SUCK more than bankrupting themselves to keep their child alive.

Well, there’s one way to make them equally happy: the insurance company runs the prescription drug benefit. They make money off of every prescription filled.

But in many if not most cases, the copays they get from policyholders are not enough to cover the cost of the drugs as charged by the suppliers. Some drugs are relatively cheap, some aren’t; that’s a matter of prices set by the pharmaceutical makers. Also, if I’m not mistaken the copays are split with the pharmacies filling the scrips, although I’m not certain what the percentages are.

I do love the automatic assumption that fat people die younger, really cute, especially since most of the fat people whom I have known personally or to whom I have been related have lived well into their 80’s & 90’s.

The whole health care thing is one confusing & frightening clusterfuck, or so it seems. I do know that it seems as if insurance companies are believing these days that they are supposed to have more control over the ‘behaviors’ of their customers & are pushing all the “we do not want to pay for illness caused by lifestyle choices” bullshit pretty heavily. I personally know someone who is being hounded, sent literature in the mail & called on the phone several times weekly by a nurse working for his insurance company trying to strongarm him into making “lifestyle changes”, based on their totally erroneous beliefs about how he lives, which will supposedly reduce his risks of getting certain diseases, such as suggesting an “exercise program” for a man who works on his feet from 9 to 10 hours daily, plus walks from one to two hours or sometimes more every day. They are feeding us a lot of bullshit in an attempt to get out of paying benefits as much as possible…but they are more than willing to collect the premums.

And then there are some political candidates who want to force us all to go to doctors whether or not we want or need to do so. I am one of those ‘weird’ people, I hate & fear doctors & medical procedures, have seen much malpractice, both with myself hurt by it & with family members who died because of the incompetence or neglect of medical people, so I avoid doctors like the plague & refuse to go to one unless I have absolutely no choice. I do not want someone telling me that is not my right.

However, I admit freely that I don’t know what the right answers are. I DO know that the idea that fat people are shorter-lived or less healthy than thin people is bullshit.

Becky, from way upthread, thank you so much for your kind words about my long-winded comments. :) I enjoy reading your comments too. I have learned a lot from this thread because as much as I like to think I am a compassionate person and aware of the issues that others face, I am fortunate enough to always have been covered by good employer-provided group health insurance (first by my parents’ employer, then by my own, now by my husband’s because his company’s spouse coverage was actually better than what I could get through my own job). So I don’t REALLY understand. Stories like the ones Sniper and Christine mentioned just make me want to die. With nobody proposing true universal health care, what are these people supposed to do?

Out of curiosity, Lisa, how are you tallying up the monetary value of contributions to society?

To pennylane, from yesterday — I’m sorry for stepping out.

I wasn’t monetizing, really, when I said there is a difference in value added between what doctors provide and what professors of English provide. It’d be nonsensical to monetize that as such. They’re too different. It’s a category error.

But when you’re talking health care policy you do have to monetize. I’m saying that if Jane Random Person has just been diagnosed with colon cancer metastasized to the liver and can expect a 2-year median survival with treatment or a few months tops without, UNLESS she can get a top liver surgeon to operate and give her a fighting chance of living a long and full life? She would “need” that surgery in a different sense than the sense in which Helen Vendler’s graduate seminar on Keats, which comes to mind because it was one of the most astounding and impressive and fulfilling classes I’ve ever sat in on and gave me an abiding faith in and sense of humanity’s intellectual potential, “needs” to be given. Now, does that seminar need to be given? Hell to the fuck to the yes. But we “need” top docs in a different way than we “need” top profs. It’s OK to me that Jane Random Person might have to pay (raise, borrow, obtain funding for) $50K out of pocket her own self for the tuition to take that poetry class, in a way that it isn’t OK to me for her to have to pay (raise, borrow, etc) $50 out of pocket for that lifesaving medical treatment.

Again, if it’s an entitlement, and if everybody deserves to have every lifesaving treatment funded, we run into trouble because there really ISN’T enough money for parity of top care across the board regardless of illness, treatment, etc. We’re talking diseases that can max your million-dollar ceiling out in eight months. Do we add the $100,000-a-year biologic agent to the 87-year-old metastatic cancer patient’s treatment? I don’t know. I think it depends on the particular 87-year-old and the particular cancer. In some cases, yes. But who’s going to be in charge of making that call? And what kind of laws and pressures will be brought to bear on them? And that’s where you come back around to how fat people are going to make out in a universal system with all the attending algorithms and criteria and metrics and pay-for performance mechanisms.

But the issue of healthcare provider compensation as such is probably a red herring since, as spacedcowgirl said, “Medicine is a challenging field that requires a special type of person to be successful at it, and I think that generally recognized fact would continue to be rewarded with prestige and decent pay.” Though, Kaethe, I am also concerned about the quality and quantity of nursing and support staffing that will be paid for.

“So we also have universal mansions, gold bathroom fixtures, and trips to Aruba” cracked my shit up really hard, in a dark way.

I’m not a Libertarian, btw, and I don’t have a final yes or no opinion on universal healthcare. A lot of me thinks it can’t be worse and may be better than the status quo. (For capitalist as well as humanitarian reasons — I’d be out there doing a start-up myself if insurance weren’t tied to my current on-staff corporate job.) I just have a fair amount of knowledge of the industry that feeds into a really, really strong sense of caution about, um, well, every proposal I see, really.

I’ve taken the quote from this topic and used it in The Age Newspaper’s Blog. I herein call every person who discriminates against fat a member of the IGNORAZZI. Its easier that saying “people who don’t get it, people who discriminate against fat” etc etc. Anyway, article link is here: http://blogs.theage.com.au/lifestyle/chewonthis/archives/2008/02/_how_did_we_bec.html
I mention in one of my posts my experience of hearing on at least 5 different occasions “Geez I wouldn’t want to f*** her” from various men. I’m annoyed that the editors took out my reference to fat discrimination also being a form of sexual discrimination and left out my sentence “I would not risk a lousy bonk when I could go home by myself and be guaranteed of a good result”.

Wow, I *love* this discussion! So many intelligent people here…it’s intimidating.

we run into trouble because there really ISN’T enough money for parity of top care across the board regardless of illness, treatment, etc.

I like where you’re coming from with this, but lots of people don’t get top care now. Lots of people don’t get any care now. And as far as I can tell, the advantages of universal health care aren’t that everyone can go to the best oncologist in America, it’s that *everyone* can get a mammogram (men get breast cancer, too!). And when you can catch your more serious diseases at an early stage, not only is there a lower mortality rate, it costs a lot less. When we’re talking about preventative care, we’re saving even *more* money, even if we don’t care about preventing unnecessary deaths. Publically fund the flu vaccine, save 40,000 people a year. If we assume people are inherently worth millions of dollars, then we’ve just saved a hell of a lot of money. Give people a cervical cancer vaccine, stop having to treat a lot of people for cervical cancer. So not only are we not paying for insurance company profits, we’re not paying for end-stage care for diseases we’ve caught early and we’re not paying to treat pretty much *any* diseases that have available and simple prophylaxis. If we’re talking about having limited funds, I literally cannot imagine an expansion of Medicaid (which is, actually, pretty well run) that wouldn’t *save* us money. Along with saving a hell of a lot of lives.

I found this article a bit confusing. I mean, the true “costs” to the system are not by individual but by year of life. Also, it’s ignoring the input to the economy that healthy and living people add if they are working. That is, if the obese cost 6,200 / year over age 20 but live 4 years less, then to compare apples to apples first you have to add in 6,200*4 to the costs for thin people, which makes the cost differential only 20,000. In addition, it depends on how “productive” those 60 or 64 years are. I don’t necessarily mean adding to the GNP, but comparing someone who’s in good shape and able to interact with their grandkids or putter around the house with someone who can’t walk a mile or can’t take care of their own food needs, e.g. If cancer is a more expensive illness in medical costs, how does it compare in terms of personal costs?